SUMARDI, KUSUMO
NPI: 1811037435
· LA VERNE, CA 91750
· General Practice Dentistry
· NPI assigned 02/06/2007
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
1,285 |
$19K |
| 2019 |
1,345 |
$27K |
| 2020 |
401 |
$5K |
| 2021 |
512 |
$7K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
381 |
381 |
$14K |
| D1110 |
Prophylaxis - adult |
123 |
123 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,906 |
639 |
$8K |
| D0274 |
Bitewings - four radiographic images |
386 |
386 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
143 |
143 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
459 |
459 |
$5K |
| D1120 |
Prophylaxis - child |
104 |
104 |
$3K |
| D5750 |
|
15 |
15 |
$3K |
| D5751 |
|
14 |
14 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$144.00 |